DISCUSSION
Left ventricular pseudoaneurysm occurs when the rupture of all cardiac
layers is contained by pericardial adhesions or fibrotic tissue. Frances
et al.,¹ in a systematic review in this group of patients, described
that the main symptoms presented are congestive heart failure, chest
pain and dyspnea, compatible with the signs verified in the present
report.
Among the determining factors for the occurrence of pseudoaneurysm, AMI
stands out, through rupture of the ventricular wall with absence of
hemopericardium and cardiac tamponade, especially in AMI affecting the
inferior wall². The presentation can be late, varying from months to
years.³
The risk of rupture demonstrated in cases of pseudoaneurysm producing
hemorrhagic events is 35-40%. However, due to the risk of imminent
mortality, surgical approach is imperative after diagnosis. It is
important to note that most cases are managed in the chronic phase and
about 10% are asymptomatic.4
The surgical team opted for preoperative cinecoronarioangiography.
Despite the diagnostic suspicion and the inherent risks, left
ventriculography was not performed, which should be considered in the
approach of these patients.5